Autologous Bone Marrow Transplantation - Blog Science Connections

First-Remission Autograft forAML 25
The first 13 patients received two doses of 50 mg/kg of cyclophosphamide
and 950 cGy as a single fraction in total body irradiation (TBI), at a low-dose rate
of 5.5 cGy/minutes. The autologous marrow was stored at 4°C for 54 hours
before reinfusion. To improve the antileukemic effect, the next 10 patients were
given 110 mg/m 2 of melphalan, 6 x 200 cGy of TBI with lung shielding to 1,000
cGy, and the cryopreserved autologous marrow.
Overall, nine patients died, eight of recurrent leukemia and one of a
cerebral hemorrhage after 36 months of complete remission (CR) following the
graft. Of the 14 living patients, one relapsed but has been in second remission
for 12 months, and one patient had a leukemic regeneration but is stable 3
months later. The other 12 patients remain in CR, 8 between 24 and 60 months
after the autograft. The predicted overall survival rate is 52%, and leukemia-free
survival rate is 54% at 5 years (Fig 1).
The leukemia-free survival rate of patients in the cyclophosphamide plus
TBI group was 49% and in the melphalan plus TBI group, 51%, although the
latter patients have had shorter follow-up. Those who had received more
chemotherapy before autograft (but who were in remission longer) tended to
have fewer relapses. Of the 13 patients who received autografts within 5 months
of achieving CR, 7 have relapsed, whereas of the 10 patients autografted
beyond 5 months of CR, 3 have relapsed.
MONTHS POST-ABMT
Figure 1. Leukemia-free survival rate (line A) of 54% and survival rate (line B) of 52% in 23
patients with consecutive autografts for acute myeloid leukemia in first remission. Data
from the Glasgow study (6).